Vauthey Jean-Nicolas, Pawlik Timothy M, Abdalla Eddie K, Arens James F, Nemr Rabih A, Wei Steven H, Kennamer Debra L, Ellis Lee M, Curley Steven A
Departments of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 444, Houston, TX 77030, USA.
Ann Surg. 2004 May;239(5):722-30; discussion 730-2. doi: 10.1097/01.sla.0000124385.83887.d5.
Extended hepatectomy may be required to provide the best chance for cure of hepatobiliary malignancies. However, the procedure may be associated with significant morbidity and mortality.
We analyzed the outcome of 127 consecutive patients who underwent extended hepatectomy (resection of > or = 5 liver segments) for hepatobiliary malignancies.
The patients underwent extended hepatectomy for colorectal metastases (n = 86; 67.7%), hepatocellular carcinoma (n =12; 9.4%), cholangiocarcinoma (n =14; 11.0%), and other malignant diseases (n =15; 11.5%). Thirty-two left and ninety-five right extended hepatectomies were performed. Eight patients also underwent caudate lobe resection, and 40 patients underwent a synchronous intraabdominal procedure. Twenty patients underwent radiofrequency ablation, and 31 underwent preoperative portal vein embolization. The median blood loss was 300 mL for right hepatectomy and 600 mL for left hepatectomy (P = 0.02). Thirty-six patients (28.3%) received a blood transfusion. The overall complication rate was 30.7% (n = 39), and the operative mortality rate was 0.8% (n = 1). Significant liver insufficiency (total bilirubin level > 10 mg/dL or international normalized ratio > 2) occurred in 6 patients (4.7%). Multivariate analysis showed that a synchronous intraabdominal procedure was the only factor associated with an increased risk of morbidity (hazard ratio [HR], 4.9; P = 0.02). The median survival was 41.9 months. The overall 5-year survival rate was 25.5%.
Extended hepatectomy can be performed with a near-zero operative mortality rate and is associated with long-term survival in a subset of patients with malignant hepatobiliary disease. Combining extended hepatectomy with another intraabdominal procedure increases the risk of postoperative morbidity.
为了给肝胆恶性肿瘤患者提供最佳治愈机会，可能需要进行扩大肝切除术。然而，该手术可能会带来较高的发病率和死亡率。
我们分析了127例连续接受扩大肝切除术（切除≥5个肝段）治疗肝胆恶性肿瘤患者的手术结果。
患者接受扩大肝切除术治疗的疾病包括结直肠癌肝转移（n = 86；67.7%）、肝细胞癌（n = 12；9.4%）、胆管癌（n = 14；11.0%）和其他恶性疾病（n = 15；11.5%）。共进行了32例左半扩大肝切除术和95例右半扩大肝切除术。8例患者同时接受了尾状叶切除术，40例患者同期进行了腹腔内手术。20例患者接受了射频消融治疗，31例患者接受了术前门静脉栓塞术。右半肝切除术的中位失血量为300 mL，左半肝切除术为600 mL（P = 0.02）。36例患者（28.3%）接受了输血治疗。总体并发症发生率为30.7%（n = 39），手术死亡率为0.8%（n = 1）。6例患者（4.7%）出现严重肝功能不全（总胆红素水平>10 mg/dL或国际标准化比值>2）。多因素分析显示，同期腹腔内手术是唯一与发病率增加风险相关的因素（风险比[HR]，4.9；P = 0.02）。中位生存期为41.9个月。总体5年生存率为25.5%。
扩大肝切除术可实现接近零的手术死亡率，部分恶性肝胆疾病患者可实现长期生存。将扩大肝切除术与另一项腹腔内手术联合进行会增加术后发病风险。
